Utility of 1% Tropicamide in Improving the Quality of Images for Tele-Screening of Diabetic Retinopathy in Patients with Dark Irides
Abstract
Purpose To compare the quality of fundus photographs taken before and after instillation of one drop of tropicamide. Methods The 45º fundus photographs were taken with a non-mydriatic fundus camera in three conditions of the pupil; pre-mydriatic, 10 minutes after one drop of tropicamide, and fully dilated. Two photographs were taken in each condition; one centered on the macula and the other on the optic disc. Two vitreoretinal specialists graded the images. Results A total of 1768 fundus photographs of 149 diabetic patients with dark irides were included. There were more ungradable images (38.1% and 50.3%, graders 1 and 2, respectively) in the non-mydriatic state than partially- (4.6% and 11.5%) or fully-dilated (15.4% and 10.0%) conditions (p Conclusion Non-mydriatic fundus photographs have a high rate of ungradable images in patients with dark irides. Instillation of only one drop of tropicamide improves the quality of fundus photographs, which is not furthered by adding more drops. This strategy can be used in tele-ophthalmology programs.
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Multiple studies have shown that diagnostic rates can be increased by a reflexive dilation protocol, but utilization has been found to be challenging.
“While multiple studies have shown that diagnostic rates can be increased by a reflexive dilation protocol,60,61 utilization has been found to be challenging.”
From Autonomous Artificial Intelligence in Diabetic Retinopathy Testing—Lessons Learned on Successful Health System Adoption (2026) · cites this paper as [61]
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Mydriasis and glaucoma: exploding the myth. A systematic review
Pandit, R. J., & Taylor, R. (2000) · Diabetic Medicine · doi:10.1046/j.1464-5491.2000.00368.x · Cited by 94 · see citing works
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Piyasena, M. M. P. N., Yip, J. L. Y., MacLeod, D., Kim, M., & Gudlavalleti, V. S. M. (2019) · BMC Ophthalmology · doi:10.1186/s12886-019-1092-3 · Cited by 70 · see citing works
Teng, C. W., Patel, S. D., Barkmeier, A. J., Liu, T. Y. A., Myung, D., Henderer, J., Liu, J., Hansen, E., & Al-Aswad, L. A. (2026) · Ophthalmology Science · doi:10.1016/j.xops.2025.100935 · Cited by 23 · see citing works
“45,49 While multiple studies have shown that diagnostic rates can be increased by a reflexive dilation protocol, 60,61 utilization has been found to be challenging.”
Chotcomwongse, P., Ruamviboonsuk, P., Karavapitayakul, C., Thongthong, K., Amornpetchsathaporn, A., Chainakul, M., Triprachanath, M., Lerdpanyawattananukul, E., Arjkongharn, N., Ruamviboonsuk, V., et al. (2025) · Ophthalmology and Therapy · doi:10.1007/s40123-024-01086-8 · Cited by 9 · see citing works
- Authors
- Banaee, T., Ansari-Astaneh, M.-R., Pourreza, H., Faal Hosseini, F., Vatanparast, M., Shoeibi, N., & Jami, V.
- Affiliations
- Mashhad University of Medical Sciences (IR)
- Retina Research Center, Khatam-al-Anbia Eye Hospital, Mashhad University of Medical Science, Mashhad, Iran
- Department of Computer Sciences, Department of Computer Engineering, School of Engineering, Ferdowsi University of Mashhad, Mashhad, Iran
- Department of Computer Engineering, School of Engineering, Ferdowsi University of Mashhad, Mashhad, Iran
- Ferdowsi University of Mashhad (IR)
- Venue
- Ophthalmic Epidemiology
- Publisher
- Informa UK Limited
- Published
- 2017-06-28
- Volume
- 24
- Issue
- 4
- Pages
- 217-221
- ISSN
- 0928-6586 (ISSN-L)
- 1744-5086
- OpenAlex
- W2730633455
- Cited by
- 19
- References
- 1
- Citations by year
- 2026: 3 · 2025: 2 · 2024: 2 · 2023: 3 · 2022: 1 · 2020: 2 · 2019: 3 · 2018: 3
- FWCI
- 1.63
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Ophthalmic Epidemiology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Retinal Imaging and Analysis
- Health Sciences › Medicine › Ophthalmology › Ophthalmology and Visual Health Research
- Health Sciences › Medicine › Ophthalmology › Retinal Diseases and Treatments
- Keywords
- tropicamide, diabetic retinopathy, teleophthalmology, fundus photography, image quality, pupil dilation, test-retest reliability
- MeSH terms
- Adult, Diabetic Retinopathy, Dose-Response Relationship, Drug, Female, Fluorescein Angiography, Fundus Oculi, Humans, Iris, Male, Mass Screening, Mydriatics, Ophthalmic Solutions, Photography, Retina, Retrospective Studies, Telemetry, Tropicamide, Reproducibility of Results
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